By Randall K. O’Bannon, Ph.D., NRLC Director of Education & Research
Editor’s note. Dr. O’Bannon is NRLC’s expert on a host of topics, including what are now called “medication” or “medical” abortions, which refers to the two-drug chemical abortion “technique.”
As such Randy is on top of all the phony-baloney “studies” cranked out by the usual suspects. In this case, he was a month ahead of the major media outlets which can be counted on to uncritically regurgitate the latest “findings.”
Just this week, outlets such as Reuters discovered the gabillionth “study” that “proves” chemical abortions delivered via web-cam are safe, safe, and safe.
Dr. O’Bannon debunked the study almost exactly one month ago today.
As I hope all the posts we’ve written for you make clear, the abortion industry/abortion advocates mean not only to keep abortion legal but expand its availability by replacing doctors and clinics with webcams and chemical abortifacients.
In that light, consider “Safety of Medical Abortion Provided Through Telemedicine Compared With In Person,” just the latest of several recent studies from researchers from Planned Parenthood, the University of California – San Francisco (UCSF), and other “reproductive health” research centers.
The study reported on webcam or “telemedicine” chemical abortions performed from April 2017 to March 2018 in four states – Alaska, Idaho, Nevada, and Washington.
By looking at electronic health records, they compared 5,214 standard chemical abortions performed at 26 clinics in those four states with 738 webcam abortions–-abortions in which the woman is never physically in the same room as the abortionist.
Julia Kohn, from the Planned Parenthood national research office, headed the team. The only medical doctor in the group was Daniel Grossman, from UCSF, who has researched and advocated for chemical abortions for a number of years. The study was published online in the journal Obstetrics & Gynecology on July 9, 2019.
Their conclusions, not surprisingly, were that the webcam abortions were “comparable” to abortions managed by the clinics, and that serious complications for patients in both groups were rare. They assure readers that “No deaths were reported.”
Obviously, they want the public to believe that chemical abortions by webcam are at least as safe as abortions induced by pills dispensed by an abortionist at the clinic. Comparing reported complication rates sounds like it would the way to determine that, but it is not.
If there is some risk – and, though they try to minimize it, researchers grant there is some – the issue is not just the level of risk but how well providers are positioned to manage that risk for each category of patients. Commonsense tells you that even if the immediate risk to the woman is the same for each abortion method, if the doctors can track and manage one set of patients better than the others, it is more likely the woman’s complications will be treated and will not prove deadly.
So, the issue isn’t simply whether the web-cam chemical abortions have the same complication rate as the clinical versions. Rather the question is whether there is any data to suggest that web-cam patients might not have the access to treatment of those complications that women who abort in a clinic do.
And on this account, the study gives us reason to be greatly concerned.
Lost Patients – The Real Safety Issue
Overall, researchers say that they lost track of a quarter of patients within 45 days of their chemical abortions, troubling enough. But with those having chemical abortions via web-cam, the number of lost patients was nearly 40%.
The data thus indicates there is something about the webcam method (reduced contact = reduced compliance?) that makes keeping track of these women more difficult. That means not only that the clinic can’t track their complications, but that doctors familiar with their case, trained to deal with chemical abortions, can’t treat their complications or give researchers information or assurances as to those patients’ outcomes.
So maybe the same number suffer hemorrhages, allowing researchers to technically use that data to call both methods “equally safe.” But if the web cam patients are less likely to get treatment, or are more likely to be lost to necessary followup, the same relative risk could ultimately prove more dangerous or deadly for those patients. So, in both types of abortion, women hemorrhage, but the clinical patient gets the necessary treatment or transfusion while the webcam patient may not, facing a greater risk of bleeding to death.
The authors acknowledge that lost patients are an issue. They attempt to come up with a way of projecting risk for the missing patients by simply applying the numbers from known patients with known outcomes or even results from past studies.
This might be a way to predict incidence of complications, but it won’t tell us the outcomes or capture the special danger faced by a patient who doesn’t get timely or knowledgeable help.
Unsuccessful Follow-Up, Covered Up Complications
The study tells us that Planned Parenthood staff encouraged patients to follow up and report concerns, and that they are supposed to have made at least one follow-up phone call with all chemical abortion patients. However, they concede that “It is possible that patients may have sought care elsewhere and did not inform Planned Parenthood of doing so.”
They try arguing that patients would have been more likely to return to Planned Parenthood for followup care in order to avoid additional medical costs, but this involves a number of questionable assumptions. It presupposes that women understood they would not be charged for followup care at Planned Parenthood; that they didn’t already have insurance that would have covered them at the emergency room; and that the patients weren’t so desperate that they simply went to the nearest hospital emergency department or urgent care center they could. If they are some great distance from the Planned Parenthood clinic, a closer medical facility makes sense in an emergency.
Kohn and her team do not tell us what the practice at Planned Parenthood is in advising chemical abortion patients about getting help from outside doctors. But other prominent promoters of chemical abortions (e.g., Rebecca Gomperts of Women on Waves, Aid Access) have explicitly told women that they do not have to reveal their chemical abortions to emergency personnel when seeking treatment for excessive bleeding or other complications. They suggest the women tell doctors she is having a miscarriage and assure women that doctors cannot tell the difference.
Lying to physicians doesn’t necessarily increase or decrease immediate, inherent safety issues with either clinical or webcam chemical abortions. But, obviously, it would make keeping track of subsequent complications, their severity, and their ultimate outcome much more difficult. And that can make the process seem safer than it actually is.
Inadequate Accounting of Complications, Incomplete, or Failed Abortions
Given the unique circumstances of chemical abortion (the abortion itself generally occurring hours later outside the clinic) and the lost patients, the tracking of complications, or “adverse events” is, at best, problematic. They claim they found only 17 patients with any major “adverse event” or recorded treatment at the emergency room. These included four who were admitted to the hospital, five who had transfusions, two who had surgery (for ectopic pregnancy).
Looking more closely, though, these “clinically significant” adverse events were culled from 77 “incident reports” submitted by participating clinics. The exact nature of these “incidents” is not specified. However, earlier in the study, the authors note that “Aspiration procedures performed as a result of symptomatic bleeding, retained tissue, persistent (but not viable) gestational sac, or patient preference are not reported unless they are associated with other reportable events.” [Emphasis added]
In other words, an unsuccessful chemical abortion where there is an a surgical “aspiration” to deal with “retained tissue” doesn’t count as an “adverse event,” nor does a patient having a surgical “aspiration” procedure to deal with the bleeding, so long as the woman returns to the clinic and has it done there.
The study was able to document 73 ongoing pregnancies and 188 women who were receiving or being referred for “aspiration abortion”– meaning at least a 4% chemical abortion “failure” rate. Data appeared to show nearly all of these occurred among those receiving their abortion pills at the clinics (71 clinical versus 2 with webcam for the ongoing pregnancies, 182 versus 6 for the subsequent aspiration abortions). That the same method with the same pills would show such dramatic differences merely based on the location where a woman took the pills is counter-intuitive and raises serious questions about the completeness of the data, particularly from the webcam side.
The authors don’t have an answer for the discrepancy. “[T]here is no biologically plausible reason that medication abortion would be appreciably different with respect to safety or effectiveness given an identical medication regimen.”
Downplaying Obvious Safety Issues with Web-Cam Abortions
What seems more likely is that there is something about the process, perhaps the physical or social distance, that causes the webcam abortion patients to seek subsequent help elsewhere (for treatment of bleeding, ectopic pregnancy, completion of abortion, etc.) or to decide to abandon the process and attempt to give birth to the baby.
Given the number of patients lost and the likelihood that a number of them may have sought care from their local emergency department without telling the ER doctors about their chemical abortions, even the assurance that “There were no reported deaths” rings hollow.
For example, if a woman shows up at the emergency room hemorrhaging and bleeds to death, it would likely be reported as a complication of miscarriage, related to pregnancy rather than to abortion. Same for the rupture of an ectopic pregnancy not discovered by a clinic sonogram and whose normal symptoms (bleeding, painful cramps) may be missed because they look confusingly similar to expected chemical abortion side effects.
In summary, what we have here is another study designed to safeguard and expand abortion in America. Chemical abortions are a hedge against the impact of a crumbling industry where so many brick and mortar clinics are closing and abortionists are retiring.
The abortion industry and its researchers promote these new methods without due regard to the health and safety of its customers. Study results (such as this one) spin study results to make it appear that women aborting via webcams fare just as well or better than those meeting an actual doctor at the clinic. This conclusion blithely ignores what happened to the hundreds of women lost to follow up. Proponents just assume the best.
For Kohn and her team, it was apparently enough that most of those women probably “successfully” aborted. And that most, if not all, of those mothers appear to have survived, and escaped serious injury (though clearly, nearly all their babies did not). That seems to be the outcome they were looking for.
And if it turns out that webcam patients tend to drop out of the system at an alarming rate, they don’t see that as a reason to hold up “progress.”